Increased use of biologics in the era of TNF-α inhibitors did not reduce surgical rate but prolonged the time from diagnosis to first time intestinal resection among patients with Crohn’s disease and ulcerative colitis – a Danish register-based study from 2003–2016

Abstract

Background

During the last decade, a significant increase in the use of biologic medicine has occurred, accounting for the greatest healthcare expenditure, among inflammatory bowel disease (IBD) patients. The objective of this study was to analyse the prevalence of and time to first intestinal resection surgery in a Danish nationwide cohort of Crohn’s disease (CD) and ulcerative colitis (UC) patients, stratified on biologic treatment status.

Methods

This retrospective population-based study included IBD patients diagnosed between 2003 and 2015 identified in the Danish National Patient Registry (NPR). The frequency of first-time surgery with intestinal resection and time to surgery was analysed among CD and UC patients between 2003 and 2016.

Results

A total of 2328 CD and 2128 UC patients underwent surgery between 2003 and 2016 (23% and 10% of all incident CD and UC patients, respectively). Up until 2008, the frequency of surgery gradually declined for both patient groups and an increase in the frequency of patients receiving biological treatment was observed. Subsequently, the frequency of surgery for both CD and UC patients remained stable despite a steady increase in biologic treatment use.

Conclusions

The registered increase in the fraction of patients on biologic treatment (mostly TNF-α inhibitors) did not result in changes in the rates of major surgeries with intestinal resection in CD and UC patients.

Keywords:

• Inflammatory bowel disease
• intestinal resection
• biologic treatment
• registry study

Author contributions

All listed authors contributed to conceptualizing the research and the manuscript and participated in reviewing and validating it.

Niels Qvist, MD, DMSc: Conceptualization, Methodology, Supervision, Validation, Writing; Kasper Vadstrup, PhD: Conceptualization, Validating, Writing, Methodology; Sarah Alulis, MSc: Conceptualization, Validating, Writing, Methodology; Andras Borsi, MSc: Conceptualization, Validating, Writing, Methodology; Pia Munkholm, MD, DMSc: Conceptualization, Methodology, Validation, Writing, Supervision; Jens Olsen, MSc: Conceptualization, Formal analysis, Validating, Writing, Methodology.

Disclosure statement

The funder, Janssen Pharmaceuticals, provided support in the form of salaries to authors K.V., S.A., and A.B. Incentive was a paid vendor to Janssen Pharmaceuticals and J.O. is paid employee of Incentive. N.Q. and P.M. have no conflicts of interest to declare.

Additional information

Funding

This work was financially supported by Janssen Pharmaceuticals.